More on parenting and addiction....

...so while I'm on the topic (parenting and addiction, see previous post), I'm going to keep rolling with a thought that has plagued me for awhile. We are in treatment program number 3 right now, since we've been at this substance abuse thing for over two years, with various ups and downs. And for the third time, I am struck that the treatment model is ill-suited to foster/adoptive situations.

How so?

First, although I recognize that all kids struggling with substance abuse have underlying complexities, I feel safe in saying that kids who've been a long time in foster care tend to have an extra layer of complexity in their histories. Many have been exposed to drugs and alcohol before birth and face serious cognitive and learning disabilities. Almost by definition, they have been abandoned and sexually and/or physically abused, which is how they came to be in foster care in the first place. If they now have foster or adoptive parents attending treatment with them, those parents usually have a very thorough grasp of the child's unique needs and struggles. We have yet to work with a substance abuse counselor who takes the time to absorb that history. In fact, in two out of our three substance abuse program intake meetings, the intake counselor began to cry when I answered questions about T's early history, then cut me off, as if needing to know no more. I wasn't impressed that they were so moved, I was annoyed and alarmed that they weren't able to take a complete medical history, especially given that these are so-called "dual diagnosis" facilities who are administering psychiatric medication in some cases.

Second, it's been our experience that the substance abuse treatment programs in which we've participated have used a model for family therapy that presumes that the child has been with you since birth, and that the family dynamics are in some way contributing to the child's substance use. Of course, right? Except that in an older child adoption, whenever you're doing "family therapy", at least in our case, there might as well be a dozen people in the room. Who are T's parents? Over his lifetime, there have been five of us primary parents, and that doesn't count the 14 other foster parents with whom he spent time. It's complicated. The group family sessions are awkward for us, because when the conversation turns to family history, we all three struggle to fit our situation into the presumed model.

Third...well, I hope readers of this blog will forgive me for this one, because it might sound conceited. But: we are not your average parents. We aren't any BETTER, as people, by any stretch. But we do have a LOT of training, and we focused our training on parenting adolescents, so we aren't your average parents of a teenager, taken aback by the recent changes in our child. We are in that strange quasi-professional parent category that all foster/adoptive parents ascend to, by virtue of the seemingly endless mandatory trainings one must undergo in order to adopt from foster care. In order to be T's parents, we've been through 60 hours of county-mandated parenting training, plus annual re-certification trainings especially for parents of "extremely emotionally disturbed children", because T's social worker required it. We've also been in continuous family therapy for the entirety of our time with him, and we've worked with social workers, Department of Mental Health crisis teams, DCFS "resource" teams, special education advisors...the list goes on. Parenting a child who comes from county custody is like that - you are swept up in an enormous parenting bureaucracy. The family sessions in these substance abuse programs don't account for parents like us. They are geared toward more typical adolescent struggles.

The other night in a family session about "open communication", even T was struck by the mismatch. He turned to me and whispered "You have fat sausage toes. Also, we are WAY past this. We've had a lot more classes than everybody else. We already know all about open communication. We don't need to be here." Of course, that's not entirely true, and I told him that our issues are just like everyone else's - there can be benefits to being in a peer group. But it can be alienating to be the only family of our sort in the room, and I did appreciate his sense that we're ready for the advanced class, thank you very much.

So I'd just like to say: let's get real. Let's have child welfare agencies admit that the problem of addiction and substance abuse amongst kids with abuse histories and long engagements with foster care is HUGE. Let's not skirt the issue and leave foster and adoptive parents to traditional family group therapy. Let's meet the problem head on with specialized services that support families like ours. Then providers would have a place to refer families like us, and we wouldn't have to squeeze ourselves into a model that just isn't a good fit.

Parenting and addiction

We are at another juncture regarding T's substance abuse problem. I'll be honest that I hesitate to write about this, because I am deeply regretful about all of the older children in foster care who never find a lasting home because people fear the problems that plague abused children. Topping that list of problems is substance abuse and the mental health issues that often underpin and accompany it. So I will begin as I sometimes do by saying that nothing I am about to say causes me to regret being part of his life. (A biological parent with an addicted child would never have to give that explanation, and I love him just as strongly as any biological parent loves their child.) Amidst all of his confusion, he deserves unconditional love and recognition.

Right now, T is in outpatient substance abuse treatment and doing poorly. He did okay for awhile. He goes three times a week for four hours for a variety of individual and group therapy, drug testing and life skills sessions. Lately, he goes, but he continues to use drugs and alcohol, and he shows no signs of taking treatment seriously. (I would have liked to have had him in residential treatment, but he would not go voluntarily, so this intensive out patient treatment was an acceptable compromise at the time.)

As a friend said to me once, "Nobody becomes an alcholic because they like the taste of alcohol," meaning that there are complex issues that underpin all addiction. Certainly that is true of T. I won't even recap them here, because they are often the focus of this blog. Suffice it to say, his abuse history and mental health issues are inextricably linked to his substance abuse. I have no idea which comes first - is he abusing drugs because he has bipolar disorder and major depression, or is he failing to develop sane habits because he is an addict? In many ways it doesn't matter. The link between prolonged child abuse and addiction is well-established and harrowing. He needs to get out of his own head and escape thoughts and memories he can't process. He wasn't taught social and problem-solving skills. He learned early to use substances to find relief. As it always does, that addictive behavior escalated in his adolescence, leading to a host of problems.

T tries hard not to...poop where he sleeps, to borrow and slightly sanitize a phrase. But the chaos of his ill judgment eventually makes its way into our home. Recently he appears to have graduated from marijuana to pills, something we're sure he picked up in the treatment program, where he's been trading cigarettes for something that causes him to return home giddy and unnaturally social. He commits small crimes - begging gas money to get to treatment and spending it on cigarettes that he trades for drugs. That of course means we had to rescind his driving privileges, and that means if we want him to continue treatment, we have to take three afternoons off work each week to get him there as the facility is an hour away. He disobeys our requests, lately doesn't show up for treatment, and sometimes doesn't come home at night. He is still gentle and loving and if you talk to him about his behavior, he's very quick to recognize that there's a problem. But his self-awareness doesn't do any good - the circuitry that leads to self-governance simply isn't working. Unless and until he makes a choice to be sober, he isn't able to make any other progress or find any peace.

Parental love is a powerful thing, and it compels us to seek every avenue of assistance we can think of. At the same time, I am very familiar with the point of view that one must let go and allow the addict to determine whether or not to seek help. But let's be honest: it is nearly impossible for a parent to be that objective with a child. Addiction and mental illness are hell, and it is terribly painful and difficult to see your child enveloped in that kind of confusion. He has weeks where he is able to abstain and manage himself, and that makes the inevitable return of chaos and confusion all the more painful. I don't subscribe to a strict tough love frame of mind. I can indeed be tough - I have taken his keys, his phone, and his computer, cancelled his car insurance, rescinded his driving privileges and refused him rides around town. I won't enable him and I won't endanger him by expecting him to be capable of things that he's demonstrated he can't handle. But I believe that if he could do better, he would. He isn't willing things to be this way.

Resistance

Like other abused kids, T has developed formidable powers of resistance. It sometimes feels as if he is leading a sit-in right in the middle of our lives, though he doesn't really have a cause to protest. He's just protesting for sake of protest.

I truly believe that the origin of his resistance is a lifelong sensation of deep helplessness. Understanding where it comes from doesn't make it much easier to live with though, particularly when it is combined with a tendency toward episodes of self-destructive behavior and substance abuse.

A child with this level of resistance will make you want to tear your hair out sometimes. His behavior has, at various times, driven teachers to the brink of insanity, brought seasoned counselors to tears, and alienated friends and family. He acts as if he believes that everyone in his life is trying to FORCE him to do something, and his survival depends on completely resisting the will and wishes of others.

If you know a little about his childhood, that makes complete sense, in its own way. Adults did force him to do things, and did things to him, and constantly disrupted his life. His early life sounds to me like being strapped into a high speed rollercoaster you can't get off; it just kept going, at stomach-churning speed, plunging over steep drops and careening around disorienting turns and flipping upside down. When I think of it, I feel my own body tense up as if to say "stop!", so it's not too surprising he developed a mental habit of extreme resistance.

Today, as a young adult, that trauma translates into refusing to get out of bed, sometimes for the whole day; refusing to develop interests or activities; deliberately circumventing chores, favors and obligations, and not showing up when or where you are supposed to be if you want to make a point or feel overwhelmed. His tactics of passive resistance are extremely highly developed, and his resilience is very weak. Unfortunately, his opposition is totally indiscriminate; sometimes it seems that he resists nearly everyone and everything.

Usually at least one of us is frayed and worn from the needless power struggles, but we do have some techniques that work (sometimes):

- "I" statements. "You need to be here at 3 pm to go to treatment" creates counter-will. "I will be here at 3 pm and I'd like you to be ready to come with me" actually does work better. Not always, but more often.

- Unflinching acceptance of natural consequences. It is HARD to stand by and watch what happens if your near-adult kid refuses to do mandatory community service, for example, or get himself to his job when he's scheduled to work. But we have learned that no amount of coaching, cajoling, nagging, or offering additional incentives really makes a difference. Despite our very best efforts to help him, he is going to self-sabotage, and there are lessons he will only learn the hard (hardest) way. It is unfair to rob him of the opportunity to learn those lessons. I'd rather than he learn them while he is under my roof, before his rent money is on the line, too. So we provide guidance and choices, and then sometimes we just have to stand back and wince as he learns the consequences of his mistaken reasoning.

- Disengagement. T's behavior sometimes reflects a huge dilemma: a yawning need for attention, on the one hand, and a formidable suppressed rage on the other. The result of that is a confused attempt to meet his needs by doing things that are deliberately annoying, provocative, or downright confrontational. The only productive way to respond is to disengage. It sends the message: "I am separate from you and I have my own reality and my own feelings that you cannot control." This strategy works REALLY well to counter his resistance, because it removes the validation that comes from provoking and frustrating someone.

If that all sounds really Zen, please let me be the first to admit, it doesn't always work, and I burn out plenty often. The pointless protesting wears thin. Compassion can get you far, but some days, there's still a gap. On the upside, working with him has made me keenly aware of the fluctuations in my own will and counter-will. I notice it at work, where we are all asking one another constantly, some variation on "Can you do what I want?" and "Can I do what you want?". I hope T can grow to a baseline that allows him to participate in that normal adult kind of negotation.